Safety evaluation of a stepwise tracheostomy decannulation program in pediatric patients
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In brief
In brief
This 12-year retrospective study evaluates a four-phase stepwise tracheostomy decannulation protocol in 77 pediatric patients, demonstrating an 18.6% failure rate distributed across all phases. The phased approach—from capping trials to outpatient monitoring—identifies patients at risk for decannulation failure, with most failures due to desaturation or dyspnea.
Written by the GCMD Library team from the article.
Abstract
Purpose
In the event of failed tracheostomy decannulation, patients might have a tragic course of events. We retrospectively evaluated our stepwise tracheostomy decannulation program and examined its safety.
Methods
A 12-year retrospective study of pediatric patients was conducted. The decannulation program was performed on patients who had airway patency by laryngobronchoscopy and whose cannula could be capped during the day. A stepwise decannulation program was performed: continuous 48-h capping trial during hospitalization (Phase 1), removal of the tracheostomy tube for 48 h during hospitalization (Phase 2), and outpatient observation (Phase 3). If a persistent tracheocutaneous fistula existed, the fistula was closed by surgery (Phase 4).
Results
The 77 patients in the study underwent 86 trials. The age at the first time of the decannulation program was 6.5 ± 3.6 years. Sixteen trials failed (18.6%): 8 trials in Phase 1, 2 trials in Phase 2, 4 trials in Phase 3, and 2 trials in Phase 4. Most decannulation failures were due to desaturation in Phase 1/2 and dyspnea in Phase 3/4. The time to reintubation after decannulation was 15–383 days in Phase 3/4.
Conclusions
Patients could fail at every phase of the program, suggesting that a stepwise decannulation program contributes to safety.